OP0230 USING AN INNOVATIVE DIGITAL TOOL FOR THE ASSESSMENT AND PERSONALIZED RECOMMENDATIONS TO COPE WITH FATIGUE IN SYSTEMIC LUPUS ERYTHEMATOSUS: THE LEAF STUDY
Authors: L. Kawka, J. C. Sarmiento-Monroy, M. Ugarte-Gil, S. Geneton, M. Piga, L. Arnaud
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Fatigue is reported as the most prevalent and bothersome symptom by Systemic Lupus Erythematosus (SLE) patients as it may impair key aspects of the quality of life. Assessing and treating fatigue is therefore an important aspect of SLE care. However, fatigue management is complex due to its multifactorial nature, as well as the need for personalized care which may take time that clinicians might lack during routine consultations. Digital tools are increasingly used for clinical practice, and may offer promising opportunities to assess and manage fatigue in chronic diseases. <h3>Objectives</h3> The aim of the LEAF study was to study the usefulness of an innovative digital tool to manage fatigue in SLE, first by collecting the main characteristics and factors associated with fatigue in SLE at the individual patient-level using self-report questionnaires and then by providing automatically personalized feedback to these SLE patients as how to cope with fatigue. <h3>Methods</h3> We developed an online digital tool, the «Lupus Expert System for Assessment of Fatigue» (LEAF), which was validated with the patient association Lupus Europe. LEAF contains a multilingual questionnaire that measures the intensity and characteristics of fatigue, using the «Fonctional Assessment of Chronic Illness Therapy – Fatigue Scale» (FACIT-Fatigue), the «Multidimensional Fatigue Inventory» (MFI) and a Numerical Rating Scale (NRS), and assesses potential predictors of fatigue, including disease activity, pain, insomnia, anxiety, depression, stress, fibromyalgia (optional) and physical activity using validated self-reported instruments. Once the assessment is completed, LEAF provides automatically personalized feedback and recommendations to cope with fatigue. Participants to the LEAF study had a diagnosis of SLE confirmed by a medical doctor. Patients evaluated how helpful LEAF was and how much they would recommend it to another patient on a 0-5 scale. Fatigue characteristics were described. Associations between significant fatigue (FACIT-Fatigue&lt;34) and its determinants were evaluated in univariate and multivariate analyses. <h3>Results</h3> Between May and November 2022, 1250 participants were included in the LEAF study. Participants were mostly female (95.2%), with a median age of 43 years old (IQR: 34-51). Significant fatigue (FACIT-Fatigue&lt;34) was reported by 78.9% of patients. NRS median score for fatigue intensity was 7 (IQR: 6-8), on a 0-10 scale. MFI median scores were 15 (IQR: 12-17) for physical fatigue, 13 (IQR: 10-16) for mental fatigue, 14 (IQR: 11-16) for reduced activity and 14 (IQR: 11-17) for reduced motivation, on a 4-20 scale. In univariate analysis, SLE participants with fatigue (FACIT-Fatigue&lt;34) were more likely to be women (p=0.01), perceived their disease as more active (p&lt;0.0001), had higher levels of pain (p&lt;0.0001), anxiety (p&lt;0.0001), depression (p&lt;0.0001), insomnia (p&lt;0.0001), stress (p&lt;0.0001), and were more likely to have fibromyalgia (p&lt;0.0001), compared to patients without significant fatigue. In multivariable analysis, the parameters independently associated with fatigue were insomnia (p=0.0003), significant pain (p=0.002), fibromyalgia (p=0.008), self-reported active SLE (p=0.02), and high level of stress (p=0.045). Following LEAF feedback, 93.2% of the participants found LEAF helpful (NRS ≥ 3/5) and 92.3% would recommend it to another SLE patient (NRS ≥ 3/5). <h3>Conclusion</h3> In SLE patients, fatigue was frequent, commonly severe, and associated with a significant reduction of activities and motivation. This further confirms the urgent need to develop new tools to assess and treat fatigue in SLE. Our study demonstrates the usefulness of an innovative digital tool to manage fatigue in SLE. <h3>Acknowledgements</h3> We would like to thank all patients who have participated to the LEAF study, and in particular the patient association Lupus Europe. <h3>Disclosure of Interests</h3> Lou Kawka: None declared, Juan Camilo Sarmiento-Monroy: None declared, Manuel Ugarte-Gil: None declared, Sophie Geneton: None declared, Matteo Piga: None declared, Laurent Arnaud Consultant of: Abbvie, Alexion, Alpine, Amgen, Astra-Zeneca, Biogen, BMS, Boehringer-Ingelheim, GSK, Grifols, Janssen, LFB, Lilly, Kezar, Medac, Novartis, Oséus, Pfizer, Roche-Chugaï, Sêmeia, UCB.